Treatise on Poisons / In relation to medical jurisprudence, physiology, and the practice of physic

by Sir Robert Christison

7, and 9. On the seventh article, which respects the conduct of the prisoner after the death of the deceased, and on the ninth, which relates to the existence of a motive or inducement to the crime, nothing need be said here. But on the

8th article of the moral evidence,—comprehending the death-bed declaration of the deceased, his state of mind, his personal circumstances and other points which prove the possibility or impossibility of voluntary poisoning—a few remarks are required, because an important and little understood part of the practitioner’s duty is connected with this branch of the proof.

The question as to the possibility of the poisoning being voluntary is one upon which the medical attendant will be expected to throw some light, and into which he will also naturally inquire for his own satisfaction. In doing so his attention will be turned to circumstances purely moral, which may not only decide that question, but may also criminate a particular individual. His inquiries must therefore be conducted with discretion, and for obvious reasons should be confined as much as possible to the patient himself. They are to be conducted not so much by putting questions, as by leading him to disburden his mind of his own accord; and it is well to be aware, that there is no one of whom a patient is so ready to make a confident on such an occasion as his medical attendant.

If disclosures of consequence are made, and the attendant should feel it his duty to look forward to the future judicial proceedings and to the probability of his appearing as a witness, he ought to remember the general rule is, that his account of what the patient told him is not evidence in the eye of the law, unless it was told under the consciousness of the approach of death. Of late, however, the rigour of this principle in law has been occasionally departed from in Scottish practice; and in regard to medical facts ascertained in the way here mentioned, many strong reasons might be assigned for such relaxation. Evidence of the kind is technically called the death-bed declaration of the deceased, and is justly accounted very important.

Here it is right to take notice of a part of the death-bed evidence, although it does not properly belong to the question of suicide, because it should always be collected if possible by the medical attendant, and with much greater care than is generally bestowed on it even by him—I mean the history of the symptoms previously to his being called in. On this part of the history, including particularly the time and manner in which the illness began, medical conclusions of extreme consequence are often subsequently founded: On a single fact or two may depend the fate of the prisoner. It is not enough, therefore, in my opinion, that such evidence formed a part of the death-bed declaration. If a fact derived at second hand from the deceased, and stated too by him from memory, is a material element of any of the medical opinions on the trial, it is of much importance that the information be procured by a medical man; and that the person who procured it, whether professional or not, was aware at the time of the probability of its becoming important. Such evidence, although not collected with these precautions, is admissible; but I have so often had occasion to witness the carelessness with which the previous history of cases is inquired into both in medical and medico-legal practice, that I do not see how it is possible to put trust in evidence of the kind, unless it bear marks of having been collected with care, and under an impression of its probable consequence. These statements are well illustrated by the following example:—On the trial of Mrs. Smith for poisoning her maid-servant with arsenic, it was proved that some drug was administered by the prisoner in a suspicious manner on a Tuesday evening. Now it appeared at the trial improbable that this drug contained a fatal dose of arsenic, because to her fellow-servants, of whom one slept with her, and others frequently visited her, the deceased did not appear to be ill at all for eight hours after, or seriously ill for nearly a day. On the contrary, however, a surgeon, who was called to see her on the following Saturday, a few hours before her death, deposed that, according to information communicated by herself, she had been ill with sickness, vomiting, purging, and pain in the stomach and bowels since the Tuesday evening. This evidence, if it could have been relied on, would have altered materially the features of the case, as it would have gone far to supply what all the medical witnesses considered defective, namely, proof of the administration. But at the time the surgeon made his inquiries, he did not even suspect that the girl laboured under the effects of poison. Neither he therefore nor his patient could have been impressed with that conviction of the importance of the information communicated, which was necessary to insure its accuracy, particularly as it related to a matter usually of so little consequence in ordinary medical practice as the precise date of the commencement of an illness; and it would consequently have been rash to adopt it in face of more direct and contrary evidence. Any one who examines the details of this trial as I have reported them, will at once see how much the case turned on the point now alluded to.[^[135]]

CHAPTER III.
OF IMAGINARY PRETENDED, AND IMPUTED POISONING.

The present seems the most convenient place for noticing the general mode of procedure by which the medical jurist may detect cases of imaginary, feigned, and imputed poisoning. It is by no means easy to lay down rules for the investigation of cases suspected to be of such a kind. But an attempt will be made to state the leading points to be attended to, and to illustrate them by the circumstances of a few examples of each variety.

Imaginary poisoning should rarely be the occasion of deception or embarrassment. The same wandering of the imagination which has led to a belief of injury from poison, will commonly also lead to such extravagant notions relative to the mode of administration and the symptoms, as will infallibly point out the true nature of the case to one who is well acquainted with the real effects of poisons. It is easy, nevertheless, to conceive cases which may be embarrassing; and certainly, in every instance, the physician should proceed in his inquiries with caution.

It appears to me that in the first place, without seeming to take up at once the conviction of his patient, he should scrupulously abstain from treating it lightly, and should on the whole act rather as if he suspected poison had been given. Allowing his patient therefore apparently credit for the truth of his suspicions, the medical attendant should request him to give a full history of existing symptoms, of their origin and progress, of their relation in point of time to various meals, and of the mode and vehicle in which the supposed poison was administered. No unprofessional person can possibly go through such a narrative, without stating many circumstances which are wholly irreconcilable with the idea of poisoning generally, and still more of the administration of a particular poison.

I have met with two instances of imaginary poisoning, the nature of which was thus at once made obvious by a host of impossibilities in the narrative of the patient. One of these may be here given as an example. An elderly lady, who had certain expectancies of the death of a relation, conceived that the family of her relative had resolved to defraud her of her supposed rights. She afterwards imagined that an attempt was made to poison her, and camphor was the poison she fixed on as the article which had been administered. In its general or moral particulars the narrative was all plausible and suspicious enough; but unluckily for its consistency, she stated that the poison could only have been given in wine,—that she did not remark any particular taste in the wine,—that her illness did not begin till the day after she took it; and although she alleged, without any leading question on my part, that camphorous perspiration was exhaled on the subsequent day, the whole train of symptoms differed entirely in every other respect from a case of poisoning, and resembled closely in their origin and progress a case of slight general fever. The incompatibility of her story with the idea of poisoning with camphor will be readily understood by referring to what is afterwards said of the effects of that substance.